Antibiotic-resistant bacteria are associated with considerable morbidity, mortality, and costs. Infection rates with antibiotic-resistant Gram-negative bacteria continue to increase. As was recently outlined in President's Council of Advisors on Science and Technology (PCAST) report on antibiotic resistance, novel interventions are needed to curb the spread of antibiotic-resistant bacteria including carbapenem-resistant Gram-negative bacteria. Through an AHRQ contract, we performed a 20 ICU cluster randomized trial (BUGG study) to determine if wearing gloves and gowns for all patient contact reduced VRE and MRSA acquisition compared to the usual standard of care; the results were published in JAMA. The study showed a 40% decrease in MRSA acquisition but no effect on VRE acquisition. The differing results for MRSA and VRE led many intensivists, infectious disease physicians, hospital epidemiologists, and hospital administrators to be uncertain about whether to implement the intervention of universal glove and gown in their ICU. The original peri-anal cultures from the BUGG study were stored so that they could be analyzed in the future for other bacteria including carbapenem-resistant Gram- negative bacteria. What is not known that this application will address is whether wearing gloves and gowns for all patient contact in the ICU leads to a decrease in antibiotic-resistant Gram- negative bacteria. The overall objective of this application is to determine whether wearing gloves and gowns for all patient contact leads to a decrease in the acquisition of carbapenem- resistant Gram-negative bacteria. Our central hypothesis is that the intervention will be effective at decreasing the acquisition of carbapenem-resistant Gram-negative bacteria. The rationale for this application is that the BUGG study left an important question unanswered: What is the effect of universal glove and gown on carbapenem-resistant Gram-negative bacteria? The aim of this study is to use already collected peri-anal specimens to assess whether wearing gloves and gowns decreases the acquisition of carbapenem-resistant Gram-negative bacteria. The significance of the proposed research is that it will determine whether wearing gloves and gowns for all patient contact in the ICU setting will lead to a decrease in the acquisition of carbapenem-resistant Gram-negative bacteria. This application, if funded, has an exceedingly high probability of success because the proposed secondary analysis is based on an already completed randomized cluster trial. All of the specimens have been obtained and can be worked up in a very cost-effective manner. This allows AHRQ to answer an important question without funding from scratch a new randomized cluster trial.